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Home My WebLink About2004-119 CONT Chg Order #5/17/19 - LTM Inc CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS PROJECT: LOCATION: CONTRACTOR: CONTRACT CHANGE ORDER NO. 5 SISKIYOU BOULEVARD CONSTRUCTION DATE: JUNE 18, 2004 SlSKIYOU BOULEVARD PROJECT NO.: 99-38, SCDL D LTM INCORPORATED You are requested to perform the following described work upon receipt of an approved copy of this document or as described by the Engineer: Item No. Description Quantity Unit Price Amount Item A Drill drain holes in trash cans Lump Sum $60.33 $60.33 Original Contract Total this Change Order Previous Change Orders Revised Contract Total $174,600.00 $60.33 $5,345.62 $180,005.95 Approved By: The time provided for completion of this contract is increased by no calenda: days. This document shall become an amendment to the contract and all provisions of 'the contract will apply. Recommended By: Da~/2,/~f/ Engine /,,/ Accepted By: LTM Incorporated Box 1145 C°nt~aCter ~' -~/' ''-' ENGINEERING Tel: 541-488-5347 20 E. Main Street Fax: 541-488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.or.us G:\pub-wrks\eng\dept-admin\ENGINEER\PROJECT~1999\99-38 Change Orders\Schedule D\99-38 CO Sc D 5.doc REQUISTION FORM THIS IS A REQUEST FOR A: [ X ] Change Order (existing PO# 3611 Schedule D) ~., ! ~F ¥ OF -ASHLAND Date of Request: Required Date of Delivery/Service: Vendor Name: LTM INCORPORATED Address: PO BOX 1145 City, State, Zip MEDFORD OR 97501 Phone: Project Title: SISKIYOU BOULEVARD RECONSTRUCTION Project Number: 99-38 Services 0nly Description Siskiyou Blvd/Ashland St Reconstruction Project Change Orders No. 1 through 4 Change Order No. 5 Itemized Below (Total $60.33) Drill drain holes in trash cans Solicitation Process: [ ] Exempt ] 3 Written Quotes (copies attached) [ ] Sole Source [ X ] Invitation to Bid (copies on file) [ ] Less than $5000 [ ] Request for Proposal (copies on file) Total Cost Account Number 260.08.12.00.704200 *Please attach the Orfginal signed contract and Insurance Certificates. NO TE: By signing this r~q[~istiion fo, l~, I ce~j~ tha the above request meets with Ctiy of Ashland Soticitiation Process requirem~'nts ~d-can be provided when / G:Pubwrks\Eng\99-38 CO 5 Sch D Requisition Updated on: 7/15/02 PROJECT: LOCATION: CONTRACTOR: CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS CONTRACT CHANGE ORDER NC). '17 SISKIYOU BLVD/OTIA DATE: JUNE 18, 2004 SISKIYOU BLVD. ! 3RD STREET PROJECT NO.: 99-38 (Schedule A) LTM INCORPORATED You are requested to perform the following described work upon receipt of an approved copy of tI~is document or as described by the Engineer: Item No. Description Quantity Unit Price Amount OO17 Item A Add 1 Flowering Tree Lump Sum $429.00 $429.00 Item B Traffic Loop Layout Lump Sum $135.67 $135.67 Item C Buy/Haul/Place %" - 0 for Siskiyou Grind Lump Sum $5,750.96 $5,750.96 Item D Dig outs at Grind Area Lump Sum $27,681.05 $27,681.05 Item E Prep for Toplift Paving Lump Sum $61.35 $61.35 Item F Sternburg Bases (~ 362 Lithia Way Lump Sum $438.29 $438.29 Original Contract Total this Change Order Previous Change Orders. Revised Contract Total $802,592.60 $34,496.32 $56,266.50 $893,355.42 The time provided for completion of this contract is increased by no calendar days. This document shall become an/ar~endment to the_contract and all provisions of the contract will Recommended By: E ng ine~,~ ,~' /' D~t~ / Approved By: ,~~~'h,~.~.-._~. En/~ine/er Daf6~ Accepted By: LTM Incorporated PO Box 1145 Med,~trd OR 97~)71 C°htr~ct'o-r'///''''''' ENGINEERING Tel: 541-488-5347 20 E. Main Street Fax: 541-488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.or, us G:\pub-wrks\eng\dept-admin\ENGtNEER\PROJEC'R1999\99-38 Change Orders\Schedule A\99-38 Sch A CO 17.doc REQUISTION FORM THIS IS A REQUEST FOR A: [ X ] Change Order (existing PO~ 3611 Schedule A) CiTY OF -AS i--]! LAN D Date Required Date of Delivery/Service: Vendor Name: LTM INCORPORATED Address: PO BOX 1145 City, State, Zip MEDFORD OR 97501 Phone: Project Title: SlSKIYOU BOULEVARD RECONSTRUCTION Project Number: 99-38 Services Only Description Siskiyou Blvd/Ashland St Reconstruction Project Change Orders 1 thru 16 Change Order 17 - Itemized Below (total $34,496.32) Add 1 flowering tree Traffic loop layout Buy, haul and place 3/4 inch-0 for Siskiyou grinding Dig outs at grand area Preparation of toplift for paving Sternburg bases placement at 362 Lithia Way Solicitation Process: [ ] Exempt ] 3 Written Quotes (copies attached) [ ] Sole Source X ] Invitation to Bid (copies on file) [ ] Less than $5000 ] Request for Proposal (copies on file) Total Cost Account Number 260.08.12.00.704200 ~' ~ *Please attach the Original signed contract and Insurance Certifica~ Employee Signature: // ~'~//~~--~ SupervisorlDept. Head Signature: y~~c/)..~..._.r/x.z, ~,,J~r/¢¢¢ NOTE: By signing thi~ r~quistiion~, Ice.ha the above request meets with Ctiy of Ashland Solicitiation Process requirem?cf~ts~'nd can be provided when necessary. G:Pubwrks\Eng\DeptAdmin\Engineer~Project\99-38 Schedule A Change Orders\99-38 CO 17 Sch A Requisition Updated on: 10/13/03 CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 CITY RECORDER'S COPY '7/'i/20031 Page 1 /4 - 036ii .... i VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inet: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No THIS IS A REVISED PURCHASE ORDER Contract for the Sisk you B vd Redes gn 802,592.60 :.~,;:~. ::~: :: ::.~j~Ct ~~ applicable to Bid Schedules A, C, & D separate requisition. Bid Schedule C - 660,266.62 Contract date: Au.~ust 28, 2002 Completion date: March 2003 Revised purchase order 01-22-2003. 18,000.00 Haul Away Change Order No. 2, Multiple Projects, Revised purchase order 02-11-2003 960.00- Change Order No. 3 - Sign Post Credit N6i ~ ~ Bi~Di~cti6h~l Markers BILL TO: SUBTOTAL TAX FREIGHT TOTAL E 260.08.12.00.704200 1,864,032.20 Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 7/1/2003 Page 2 / 4 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Change Order No, 5 ' (~!;~i~ ii~ ~ii~ ~i~ 1,457.69- (B) Bid Item 38 Bicyc e Lane Stencil Change Order No. 6 - Jo nt Seal Brdge Please see attached for descriptions of Revised purchase order 05/13/2003 1,023.01 Chan0e Order ~o. ~ 0, Itoms A & B Schedule D Revisod purchase order 08/0~/2003 ~ 43.00 Chan~e Order ~ ~ Schedule C Rovised purchase order 08/0~/2003 ~04.42 . Chan~o Ordor g2 Change Order 12, Items A and B SUBTOTAL BILL TO: T~ FREIGHT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 7/1/2003 Page 3 / 4 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Revised purchase order 01/15!2004 451.29 Change Order 3 - Electrical Boxes Revised purchase order 01/22/2004 6,553.75 Chan~e Order ~ 4, Itom A & B Schedule A Revised purchase order 03/05/2004 3,931.91 Change Order 4, Items A-C Schedule A Revised purchase order 06/30/2004 20,876.64 Chan~o order ~ 8 RevJsed purchase order 06/30/2004 13,731.00 Chan~e ordor 0 Bus shelter ACHF, Plus extra bench SUBTOTAL BILL TO: T~ FREIGHT TOTAL Authorized Signature VENDORCOPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 7/i/2003 I Page 4 /4 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? NO Rev sed purchase order 06/30!2004 25,008.50 Change order 8 Adiustment to Change Order No. 5 Schedule A Revised purchase order 07/08/2004 60.33 Drill drain holes in trash cans Change Order 20 Bid Adjustment/Quantity Overage Schedule A *** This is a change order. *** SUBTOTAL 1,864,032.20 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 1,864,032.20 3 Autho~____~ Signature VENDORCOPY CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS CONTRACT CHANGE ORDER NO,. '19 PROJECT: SISKIYOU BLVD/OTIA DATE' July 8, 2004 LOCATION: SISKIYOU BLVD. / 3RD STREET PROJECT NO.' 99-38 (Schedule A) CONTRACTOR: LTM INCORPORATED You are requested to perform the following described work upon receipt of an approved copy of this document or as described by the Engineer: Item No. Description Quantity Unit Price Amount co Item A Dash numbers 47, 48, 49 Lump Sum $7,122.81 $7,122.81 Original Contract Total this Change Order Previous Change Orders Revised Contract Total $802,592.60 $7,122.81 $111,640.20 $921,355.61 The time provided for completion of this contract is increased by no calendar days. This document shall become a,p amendment to the contract and all provisions of the contract will Recommended By: ~ Engineer,~' ~ D E~~~~'~,,~g ~eei' / :~ J ~ ~' o ,-/ Approved By: Date Accepted By: LTM Incorporated PO Box 1145 Medford OR 97501 Contractor Date ENGINEERING Tel: 541-488-5347 20 E. Main Street Fax: 541-488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.or, us G:\pub-wrks\en§\dept-admin\ENGINEER\PROJEC~1999\99_38 Change Orders\Schedule A\99-38 Sch A CO 19.doc REQUISTION FORM THIS IS A REQUEST FOR A: [ X ] Change Order (existing PO# 3611 Schedule A) C! TY OF -AS idl LAN D Required Date of Delivery/Service' Vendor Name: LTM INCORPORATED Address: PO BOX 1145 City, State, Zip MEDFORD OR 97501 Phone: Project Title: SISKIYOU BOULEVARD RECONSTRUCTION Project Number: 99-38 Services Only Description Siskiyou Blvd/Ashland St Reconstruction Project Change Orders 1 thru 18 Change Order 19 - Itemized Below (total $7,122.81) Dash numbers 47, 48, 49 Solicitation Process: [ ] Exempt [ ] 3 Written Quotes (copies attached) [ ] Sole Source [ X ] Invitation to IE~id (copies on file) [ ] Less than $5000 ] Request for Proposal (copies on file) Total Cost Account Number 260.08.12.00.704200 *Please attach the onginal signed contractandlnsurance Employee Signature: ~///d /~ ,/~/~ Supervisor/Dept. Head Signature: NOTE: B y signing this' re qu is ti io~orm, l~ ~ify th a the above re quest rne ets with C b'y of Ashland Sol icifia fion Process re qu irerr)~nt~and can be prc, vide d w hen necessary. /-- G:Pubwrks\Eng\DeptAdmin\Engineer~Project\99.38 Schedule A Change Orders\99-38 CO 19 Sch A Requisition Updated on: 10/13/03 LTM Incorporated Time and Materials Billing Summary Project Name: SISKIYOU BLVD. SCH. B Job No.: 02271-47 Description of work: Install Fire Prempt (Marca) Date: 6/21/2004 LABOR N~ME B0UES E : ~I 'F~TA~ LABOR TOTAL $0.00 EQUIPMENT EQUIP. TOTAL $0.00 MATERIALS MATERIAL TOTAL $0.00 SERVICES / MISC. 06/21/04 Marca Install Fire Preempt 10528 $2,603.90 $2,603.90 SERVICES TOTAL $2,603.90 Costs Subtotal (no markup) Labor Mark-up 15% Sub Contractor Mark-up 0% $2,603.90 $0.00 $0.00 Submitted by: Accepted by: Joh ot' tion TOTAL AMOUNT DUE Superintendent Date: $2,603.90 LTM Incorporated Time and Materials Billing Summary Project Name: SISKIYOU BLVD. SCH. B Job No.: 02271-48 Description of work: Install Signal Head (Marca) Date: 6/21/2004 LABOR LABOR TOTAL $0.00 EQUIPMENT EQUIP. TOTAL $0.00 MATERIALS MATERIAL TOTAL $0.00 SERVICES / MISC. 06/21/04 Marca Install Signal Head 10528 $1,341.67 $1,341.67 SERVICES TOTAL $1,341.67 Costs Subtotal (no markup) Labor Mark-up 15% Sub Contractor Mark-up 10% $1,341.67 $0.00 $134.17 Submitted by: Accepted by: C~struction Superintendent Date: /,, LTM Incorporated Time and Materials Billing Summary Project Name: SISKIYOU BLVD. SCH. B Job No.: 02271-49 Description of work: Curb & Gutter (3rd street) Take Forms Down & Reset Date: 7/1/2004 LABOR LABOR TOTAL $0.00 EQUIPMENT EQUIP. TOTAL $0.00 MATERIALS MATERIAL TOTAL $0.00 SERVICES / MISC. 07/01/04 Ourb & Gutter, Take Down Forms $2,826.04 $2,826.04 SERVICES TOTAL $2,826.04 Costs Subtotal (no markup) Labor Mark-up 15% Sub Contractor Mark-up 10% Sub Contractor Mark-up 8% $2,826.04 $0.00 $200.00 $66.08 Submitted by: Accepted by: Jo struction TOTAL AMOUNT DUE Superintendent Date: $3,092.12 CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: C!'TY R '""r" nER'S COPY Page 1 / 4 ~ ;PONUMBER 03611 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No 'HIS IS A REVISED PURCHASE )RDER Contract for the Sis~ Blvd Red~ to Bid Schedules C, & D re~ uisition. Bid Schedule C - 660,266.62 Contract date: Au.qust 28, 2002 date: March 2003 Revised purchase order 01-22-2003. Haul Away Change Order No. 2, Multiple Projects, Revised purchase order 02-11-2003 Change Order No. 3 - Sign Post Credit Markers 18,000.00 960.00. BILL TO: 260.08.12.00.704200 Authorized Signature I 1 856 909.39 SUBTOTAL TAX FREIGHT TOTAL VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: SHIP TO: Ashland Public Work,,; (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? NO Page 2 / 4 [ "'036il "~ Order No. 5 Bid Item 38 Bi~ Lane Stencil ~e Order No. 6 - Joint Seal Bri~ Schedule A Please see attached for descri Revised order 05/13/2003 le Order No. 10, Items A & B Schedule D Revised purchase order 08/01/2003 Change Order #11 Schedule C Revised purchase order 08/01/2003 Change Order #2 Change Order 12, Items A and B of 1,023.01 143.00 604.42 BILL TO: SUBTOTAL TAX FREIGHT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: SHIP TO: Ashland Public Work,,; (541) 488-5587 51 WINBURN WAY ASHLAND, OR 97520, Req. No,: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Page 3 / 4 [ ' 036'ii ...... ~ Revised order 01/15/2004 e Order 3 - Electrical Boxes Schedule A Revised order 01/22/2004 Order 14, Item A & B Schedule A Revised order 03/05/2004 ~nge Order 4, Items A-C Schedule A Revised purchase order 06/30/2004 Change order 18 Revised purchase order 06/30/2004 Change order 6 Bus shelter ACHF, Plus extra bench 6,553.75 3,931.91 20,876.64 ' 13,731.00 BILL TO: SUBTOTAL TAX FREIGHT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: 7;1/2003 .... SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Page 4 / 4 Revised e order 8 order 06/30/2004 ustment to Char Schedule A e Order No. 5 Revised order 07/08/2004 Drill drain holes in trash cans ~ Order 20 Adjustment/Quantity Overage 60.33 BILL TO: Account Payable SUBTOTAL 20 EAST MAIN ST TAX 0.00 541-552-2028 FREIGHT 0.00 ASHLAND, OR 97520 TOTAL 1,856,909.39 Auth~__d~ed Signature VENDOR COPY REQUISTION FORM THIS IS A REQUEST FOR A: [ X ] Change Order (existing PO~ 3611 Schedule A) CITY OF SHLAND Date of Request: Required Date of Delivery/Service: Vendor Name: Address: City, State, Zip Phone: Project Title: Project Number: LTM INCORPORATED PO BOX 1145 MEDFORD OR 97501 SISKIYOU BOULEVARD RECONSTRUCTION 99-38 Services Only SoliCitation proce,'~s. · [ ] Exempt [ ] 3 Written Quotes (copies :- : attached) [ ] Sole Source [ X ] InVitatlor! to Bid (copies on- file) [ ] Less than $5000 [ ] ReqUest for Proposal (copies I °n file) Description Siskiyou Blvd/Ashland St Reconstruction Project :hange Orders 1 thru 19 Change Order 20 - Itemized Below (total $25,702.10) "~ -n~-~-h ?.'-'.,"~,~cm 47, 'I, 8, 49 Total Cost Account Number 260.08.12.00.704200 ~ ~/~~ *P/easeattachtheOr~'nalsignedcontractandlnsuranceCertiflcates. . Employee Signature: NOTE: By signing thi~ ~equistiio~orm,~rtify tha the above request meets with Cb'y of Ashland Solicitiation Process requiremen~nd~an be provided when necessary. G:Pubwrks~Eng~DeptAdmin~ngineer~Project~99-38 Schedule A Change Orders~99-38 CO 20 Sch A Requisition Updated on: 10/13/03 CITY OF ASHLAND 20 E MAIN ST. ASHLAND, (:)R 97520 (541) 488-5300 CITY RECORDER'S COPY 7/1/2003 Page 1 / 4 03611 I VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No THIS IS A REVISED PURCHASE ORDER ~gDtr~t.. fgr' ~he Si~iyg~ BI.~¢ ~de~ign 8o2,592~6o ap.p.li~.~!e t9 Bi~ S~hed~lgs ~ire sep~rme requisition. Bid Schedule G - 880,288.82 Oon~rso~ dste: Auflus~ 28, 2002 Gomple~Jon ds~e: ~sr~h 2003 Revised pur'oh~se order 0~-22-2003. ~ 8,000.00 Hsul Awsv Ohsnge Order No. 2, ~ul~iple Projects, Revised pumh~se order 024 ~-2003 gS0.00- Ohsnge Order No. 3 - Sign Pos~ Oredi~ ~srkers SUBTOTAL BILL TO: FREIGHT TOTAL E 260.08.12.00.704200 1,771,642.14 Authorized Signature VENDOR COPY CITY OF ASHLAND 2O E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 I 7/1/2003 [ Page 2 / 4 03611 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97'501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Change Or;der No, 5 !,457.69- (B) Bid Item 38 Bicycle Lane Stencil ::!. :;.: : iii: i~i~i::~[~:~ii~?~ !~:~i~i~i~:::~ii~:: :.~::~.:: : ~: :~::: :~: ::~: :: ~.~: Change Order No. 6 - Joint Seal Bridge 1,471.13 Schedule A Please see attached for descriptions of Revised purchase 0rde[ 05!!3/2003 !,023,01 Change Order No. 10, Items A & B :. ~.~0 Schedule D Revised purchase order 08/01/2003 143.00 Change Order ¢11 Schedule C Revised purchase order 08/01/2003 604.42 :::: ::::::::::::::::::::::::::::: ::::: ::::: :::: :::::::::::::::::::: ::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::::::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::???: ::::: :::::::::::::::::::::::::::::::: Change Order ¢2 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ?:::::::::: ::::::::::::::::::::::::::::::: :::: ::::::::::::::::::::::::::: ::: ::::::::::::::::::;::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :: :: ::::::::::::::::::::::: :: :::::::::: :::::: ::::::::::::::::::::::::::::::: :::::: ::: :::: ::::::::::::::: :::::::::::::::::::::: Change Order 12, Items A and B :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::: ::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::: :: :::: :::::::::::::: :::::::::::: :::::::::::::::::::::::::::::::::::::::::::::: ::::::::: ::: :::::::::::::::::::::::::::::::: :::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::: :: :: :: :::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :: ::::::::::::::::::::::::::::::: ::::::::: ::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::: :::::::::::::::::::::::::: SUBTOTAL BILL TO: T~ FREI6HT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 7/1/2003 Page 3 / 4 03611 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WlNBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Reyised purchase order 01!15/2004 451.29 Change Order 3 - Electrical Boxes Schedule A Revised purchase order 01/22/2004 6,553.75 Change Order 14, Item A & B Schedule A Revised purchase order 03/05/2004 3,931.91 Change Order 4, Items A-C :: 1 ~: :~1: :':: :::1:: ; : : : Schedule A Revised purchase order 06/30/2004 20,876.64 Change order 18 Revised purchase order 06/30/2004 13,731.00 Change order 6 Bus shelter ACHF, Plus extra bench SUBTOTAL BILL TO: T~ FREIGHT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-53100 7/1/2003 Page 4 / 4 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No *** This is a change order. *** SUBTOTAL 1,771,642.14 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 1,771,642.14 ASHLAND, OR 97520 Author,~;~ignature VENDOR COPY REQUISTION FORM CITY OF SHLAND Date of Request: THIS IS A REQUEST FOR A: [X ] Change Order (existing PO~ 3611 Schedule D) Required Date of Delivery/Service: Vendor Name: LTM INCORPORATED Address: PO BOX 1145 City, State, Zip MEDFORD OR 97501 Phone: Project Title: SlSKIYOU BOULEVARD RECONSTRUCTION Project Number: 99-38 Services Only Solicitation Process: [ ] Exempt [ ] 3 Written Quotes (copies attached) [ ] Sole Source [[ X ] Invitation to Bid (copies on tfile) [ ] Less than $5000 [ ] Request for Proposal (copies on file) .... Description Total Cost Change Order No. 6 Itemized Below (Total C om pensati ng for quantity adjustment Bus shelter ACHF)Plus extra bench Account Number 260.08.12.00.704200 *Please attach the Odginal signed contract and Insurance Certificates. Employee Signature: ~ ,//~ ~~--~-'~ Supervisor/Dept. Head Signature: /~.~~/'~~ NOTE: By signing this requistiion~rm. I ~¢tify tha the above request meets with Ctiy of Ashland Solicitiation Process require~nts~nd can be provided when necessary. G: Pubwrks\Eng\99-38 CO 6 Sch D Requisition Updated on: 7/15/02 REQUISTION FORM CiTY OF -/kS H! LAN D Date of Request: THIS IS A REQUEST FOR A: [ X ] Change Order (existing PO~ 3611 Schedule A) Required Date of Delivery/Service: Vendor Name: Address: City, State, Zip Phone: Project Title: Project Number: LTM INCORPORATED PO BOX 1145 MEDFORD OR 97501 SISKIYOU BOULEVARD RECONSTRUCTION 99-38 Solicitation Process: Exempt [ ] 3Written Quotes (copies attached) Sole Source [ X ] InvitatiOn t° Bid (coPies On file) Less than $5000 [ ] Request for Proposal (copies on file) Services Only Description Total Cost Siskiyou Blvd, Ashland St Reconstruction Project Change Order 18 - Itemized Below (total $20,876.64) Compensating for quantity adjustment Account Number 260.08.12.00.704200 ~~~tha t~he *Pleaseattachthe onginalsignedcontractandlnsurance Certific~~ u '-z-------_ ~--~re ~tswithctiy~fAsh~andS~icitiati~nPr~c~ssrequirern~san~c~nb~pr~dd~dwh~nn~c~ssary~ Employee Signature: ~ Ice tha above quest S pervisor/Dept. Head Signature: NOTE: By signing thi '" G: Pubwrks\Eng\DeptAdmin\Engineer~Project\C.~:J-38 Schedule A Change Orders\99-38 CO 18 Sch A Requisition Updated on: 10/13/03 CITY OF ASHLAND 2o E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 CITY RECORDER'S COPY I 7/1/2003 Page 1 /4 03611 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No THIS IS A REVISED PURCHASE ORDER :.~1~ Bi8 ~~i~ ~ ~iii ~e~i~e ~ separate requisit on Bid Schedule C - Contract date: August 28, 2002 Completion date: March 2003 Revised purchase order 01-22-2003. ; Haul Away Change Order No. 2, Multiple Projects, Revised purchase order 02-11-2003 Change Order No. 3 - Sign Post Credit Markers BILL TO: SUE;TOTAL TAX FREIGHT TOTAL 802 660,266.62 18,000.00 960.00- E 260.08,. 12.00.704200 1,796,650.64 , , , Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 Page 2 / 4 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 9;7501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? NO Change Order; No, 5 1,457.69- (~.) Bi~..:l!.~..~.:~ ~Y~!.9 ~99~9~i Change Order No. 6 - Joint Seal Bridge 1,471.13 Schedule A Please see attached for descriptions of . Revised purchase order 05/13/2003 . 1,023.01 Change Order No. 10, Items A & B Schedule D Revised purchase order 08/01/2003 143.00 Change Order ¢11 Schedule C Revised purchase order 08/01/2003 604.42 ......... ....... ....... ..... :::::: :: :: ::~ ~::::::::::~ : Change Order ¢2 Change Order 12, Items A and B ::::::::::::::::::::::: ~. ,: S U B TOTAL BILL TO: T~ FREI6HT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 Page 3 / 4 1'-' 03611 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No · Revised purchase order: 0!/! 5/2004 451,29 Change Order 3 - Electrical Boxes Schedule A Revised purchase order 01/22/2004 6,553.75 Change Order 14, Item A & B Schedule A Revised purchase order 03/05/2004 3,931.91 Change Order 4, Items A-C Schedule A Revised purchase order 06/30/2004 20,876.64 Revised purchase order 06/30/2004 13,731.00 Change order 6 Bus shelter ACHF, Plus extra bench SUBTOTAL BILL TO: T~ FREIGHT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 7/1/2003 Page 4 / 4 I--' 036i '1 I VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Revised purchase order 06/30!2004 25,008.50 ~ba~ge 9r'~7 8 Adiustment to Change Order No. 5 SUBTOTAL 1,796,650.64 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 1,796,650.64 ASHLAND, OR 97520 Aut h o rize~,,.~a'tar, e VENDOR COPY REQUISTION FORM CITY OF SHLAND Date of Request: THIS IS A REQUEST FOR A: [ X ] Change Order (existing PO# 3611 Schedule C) Vendor Name: LTM INCORPORATED Required Date of Delivery/Service: Address: PO BOX 1145 City, State, Zip MEDFORD OR 97501 Phone: Project Title: ASHLAND STREET RECONSTRUCTION Project Number: 99-38 Services 0nly Solicitation Process: [ ] Exempt [ ] 3Written Quotes (copies attached) [ ]'"Sole Source [X ] Invitation"t'0 Bid (copies on file) [ ] Less than $5000 [ ] Request for Proposal (copies Ion file) Description Total Cost Siskiyou Blvd/Ashland St Reconstruction Project Change Orders 1 through 7 Landscape material Adjustment to Chan~e Order ~o. 5 Account Number 260.08.12.00.704200 ~ __ *Please attach the Odginal signed contract and Insurance Certificates. Employee Signature: //~J~ ~~ Supervisor/Dept. Head Signature: NO TE: By signing this requistiion fo~f~, lcertify/t~the above request meets with Ctiy of Ashland Solicitiation Process requirement~nd ~n ~'~ prov~~. --/ G: Pubwrks\Eng\99-38 LTM CO 8 Scl C Requisition Updated on: 7/15/02 CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 CiTY RECORDER'S COPY I DATE 7/iFO0 Page 1 / 4 03611 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No THIS IS A REVISED PURCHASE ORDER Contract for the Siskiyou Blvd Redesign 802,592.60 applicable to Bid Schedules A, C, & D :i:i:: ~8~i~ ::~. ~[!i ~i~: [ . : : i. li;::: separate requisition. Bid Schedule C - 660,266.62 Contract date: Au.qust 28, 2002 Completion date: March 2003 Revised purchase order 01-22-2003. 18,000.00 Haul Awav Change Order No. 2, Multiple Projects, Revised purchase order 02-11-2003 960.00- Change Order No. 3 - Sign Post Credit Markers 8 U~ BTOTAL BILL TO: T~ FREIGHT TOTAL E 260.08.12.00.704200 1,831,207.29 Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 7/i/2003 Page 2 / 4 036i'i ...... I VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Change Order No 5 1,457.69- (B) Bid Item 38 Bicycle Lane Stencil Change Order No. 6 - Joint Seal Bridge 1,471.13 Schedule A Please see attached for descriptions of Revised purchase order 05/13/2003 1,023.01 Change Order No. 10, Items A & B Schedule D Revised purchase order 08/01/2003 143.00 Change Order #11 Schedule C Revised purchase order 08/01/2003 604.42 Change Order #2 Change Order 12, Items A and B S I. jl BTOTAL BILL TO: TAX FREIGHT TOTAL Authorized Signature VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 7/1/2003 Page 3 / 4 03611 VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No ..... Revised purchase order 01/15/2004 451.29 Change Order 3 ~ E ectrica Boxes . Schedule A Revised purchase order 01/22/2004 6,553.75 Change Order 14, Item A & B Schedule A Revised purchase order 03/05/2004 3,931.91 Change Order 4, Items A-C Schedule A Revised purchase order 06/30/2004 20,876.64 Change order 18 Revised purchase order 06/30/2004 13,731.00 Change order 6 Bus shelter ACHF, Plus extra bench SlJIBTOTAL BILL TO: TAX FREIGHT TOTAL Authorized Signature. VENDOR COPY CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 Page 4 / 4 036ii '/ VENDOR: 000100 LTM INC P O BOX 1145 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541 ) 488-5587 51 WlNBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net 10th of Month Req. Del. Date: 9/9/2002 Special Inst: Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No .... Re~ sed purchase order 06/30~2004 25,008.50 ' Change order 8 Adiustment to Change Order No. 5 Schedule A Revised purchase order 07/08/2004 60.33 Drill drain holes in trash cans SLJlBTOTAL 1,831,207.29 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 1,831,207.29 ASHLAND, OR 97520 Authorized Signature VENDOR COPY